Recovered-memory therapy

Recovered-memory therapy (RMT) is catch-all psychotherapy term for therapy using one or more method or technique for the purpose of recalling memories.[1] It does not refer to a specific, recognized treatment method, but rather several controversial and/or unproven interviewing techniques, such as hypnosis and guided-imagery, and the use of sedative-hypnotic drugs, which are presently rarely used in the responsible treatment of post-traumatic stress disorder and other dissociative disorders. Proponents of recovered memory therapy claim that traumatic memories can be buried in the subconscious and affect current behavior, and that these can be recovered. The term is not listed in DSM-IV nor is it recommended by mainstream ethical and professional mental health associations.[2]

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The term false-memory syndrome was coined between 1992 and 1993 by psychologists and sociologists associated with the False Memory Syndrome Foundation,[2][3] an organization that advocates on behalf of individuals who claim they have been falsely accused of perpetrating child sexual abuse.[4] These researchers argue that RMT can result in patients recalling instances of sexual abuse from their childhood that did not actually occur.[2] While not a therapeutic technique in and of itself, RMT generally is applied to such methods as hypnosis, age regression, drug-assisted interviewing (using substances such as sodium amytal), and guided visualization.[5] While practiced by some individual therapists, these techniques were never recognized by the psychiatric or psychological community, and are generally not practiced in mainstream treatment modalities.[not in citation given][6] A 1994 survey of 1000 therapists by Michael D. Yapko found that 19% of the therapists knew of a case in which a client's memory had been suggested by therapy but was in fact false.[7]

According to Charles L. Whitfield, while advocates of the False Memory Syndrome Foundation lump all therapies that deal with recovery of trauma memories into one category, regardless of past efficacy, they only attack a few of them.[8] An inquiry by the Australian government into the practice found little support for or use of memory recovery therapies among health professionals, and warned that professionals had to be trained to avoid the creation of false memories.[9] In October 2007, Scientific American published an article critical of recovered memory therapy and dissociative identity disorder diagnoses, especially in relation to the Satanic ritual abusemoral panic.[10] The International Society for the Study of Trauma and Dissociation responded by criticizing the article for using the terminology "recovered memory therapy", which they claim is a straw man for a non-existent modality, and for its skeptical view of dissociative disorder diagnosis.[11] Despite the lack of such a coherent method or training—the term sometimes crops up not only in the popular press but also in government inquiries, court proceedings, and position statements from psychologists' professional associations.[12][13][14]

A range of studies have concluded that at least 10% of physical and sexual abuse victims forget the abuse.[15][16][17] The rate of delayed recall of many forms of traumatic experiences (including natural disasters, kidnapping, torture and more) averages among studies at approximately 15%, with the highest rates resulting from child sexual abuse, military combat, and witnessing a family member murdered.[18] The rate of recall of previously forgotten traumatic events was shown by Elliot and Briere (1996) to be unaffected by whether or not the victim had a history of being in psychotherapy.[18] Williams found that among women with confirmed histories of sexual abuse, approximately 38% did not recall the abuse 17 years later, especially when it was perpetrated by someone familiar to them.[19] Hopper cites several studies of corroborated abuse in which some abuse victims will have intervals of complete or partial amnesia for their abuse.[20]

A 1996 interview survey of 711 women reported that forgetting and later remembering childhood sexual abuse is not uncommon; more than a quarter of the respondents who reported abuse also reported forgetting the abuse for some period of time and then recalling it on their own. Of those who reported abuse, less than 2% reported that the recall of the abuse was assisted by a therapist or other professional.[21]

A review article on potentially harmful therapies listed RMT as a treatment that will probably produce harm in some who receive it.[22]Richard Ofshe, a member of the advisory board to the FMSF, describes the practice of "recovering" memories as fraudulent and dangerous.[23]

Studies by Elizabeth Loftus and others have concluded that it is possible to produce false memories of childhood incidents.[24] The experiments involved manipulating subjects into believing that they had some fictitious experience in childhood, such as being lost in a shopping mall at age 6. This involved using a suggestive technique called "familial informant false narrative procedure," in which the experimenter claims the validity of the false event is supported by a family member of the subject. The study has been used to support the theory that false memories of traumatic sexual abuse can be implanted in a patient by therapists. Critics of these studies argue that the techniques do not resemble any approved or mainstream treatment modality,[25] and there are criticisms that the implanted events used are not emotionally comparable to sexual abuse.[19][26] Critics[who?] contend that Loftus's conclusions overreach the evidence.[19][25]

Some patients later retract memories they had previously believed to be recovered. While false or contrived memories are possible reasons for such retractions, other explanations[by whom?] suggested for the retraction of allegations of abuse made by children and adults include guilt, a feeling of obligation to protect their family and a reaction to familial stress rather than a genuine belief that their memories are false.[27] The number of retractions is reported[by whom?] to be small compared to the actual number of child sexual abuse allegations made based on recovered memories.[8]

A study at the Dissociative Disorders and Trauma Program of the McLean Hospital concluded that recovered memories are mostly unconnected to psychotherapeutic treatment and that memories are often corroborated by independent evidence, often appearing while home or with family and friends, with suggestion being generally denied as a factor in recovering memories.[28] Very few participants were in therapy during their first memory recovery and a majority of participants in this study found strong corroboration of their recovered memories.[28]

There are several individuals and groups that have published guidelines, criticisms or cautions about recovered memory therapy and techniques to stimulate recall:

In the Brandon Report, a set of training, practice, research and professional development recommendations, the United Kingdom's Royal College of Psychiatrists advised psychiatrists to avoid use of RMT or any "memory recovery techniques", citing a lack of evidence to support the accuracy of memories recovered in this way.[29]

In 2004, the government of the Health Council of the Netherlands issued a report in response to inquiries from professionals regarding RMT and memories of traumatic child sexual abuse.[12] The Health Council stated that while traumatic childhood experiences were major risk factors for psychological problems in adulthood, most traumatic memories are well remembered but can be forgotten or become inaccessible though the influence of specific circumstances precludes a simple description of the relationship between memory and trauma. The report also notes that memories can be confabulated, re-interpreted and even apparently vivid or dramatic memories can be false, a risk that is increased when therapists use suggestive techniques, attempt to link symptoms to past trauma, with certain patients and through the use of methods to stimulate memories.[12]

The Australian Hypnotherapists Association (AHA) issued a similar statement, for contexts where false memories of child sexual abuse may arise. The AHA acknowledges that child sexual abuse is serious, damaging and at least some memories are genuine, while cautioning that some questioning techniques and interventions may lead to illusory memories leading to false beliefs about abuse.[30]

The Canadian Psychological Association has issued guidelines for psychologists addressing recovered memories.[31] Psychologists are urged to be aware of their limitations in knowledge and training regarding memory, trauma and development and "that there is no constellation of symptoms which is diagnostic of child sexual abuse". The guidelines also urge caution and awareness of the benefits and limitations of "relaxation, hypnosis, guided imagery, free associations, inner child exercises, age regression, body memory interpretation, body massage, dream interpretation, and the use of projective techniques" and special caution regarding any legal involvement of memories, abuse and therapy.

In Ramona v. Isabella, Gary Ramona sued his daughter's therapist for implanting false memories of his abuse of her. In the first case putting recovered memory therapy, itself, on trial, he eventually was awarded $500,000 in 1994.[32]

Discussing RMT in the New South Wales Parliament in 1995, the state Minister for Health, Andrew Refshauge – a medical practitioner – stated that the general issue of admissibility of evidence based on recovered memories was one for the Attorney General.[13] In 2004 Australian Counselling Association issued a draft position statement regarding recovered memories in which it informed its membership of possible legal difficulties if they affirm accusations as true based solely upon discussion of a patient's recovered memories, without adequate corroborating evidence.[14]

A degree of controversy does remain within legal circles, with some holding the view that therapists and courts should consider repressed memories the same as they consider regular memories. Three relevant studies state that repressed memories are "no more and no less accurate than continuous memories."[33][34]

Recovered memory therapy was an issue in the criminal trials of some Catholic priests accused of fondling or sexually assaulting juvenile-turned-adult parishioners.[35][36]

Several court cases awarded multimillion-dollar verdicts against Minnesota psychiatrist Diane Bay Humenansky, who used hypnosis and other suggestive techniques associated with RMT, resulting in accusations by several patients against family members that were later found to be false.[37][38][39]

In the UK, a woman who said she had falsely accused her father of rape successfully sued the hospital and psychologist who had treated her with what she described as a form of RMT and was awarded a large out-of-court settlement.[40]